Illinois CPA Society Student Affiliate
Membership Application

 

This is not an electronic form.

Type in your information, print the page, and then sign your name on the bottom and mail or fax it to: The Illinois CPA Society, 550 W. Jackson, Suite 900, Chicago, IL 60661-5716, Phone: 312/993-0393 Fax: 312/993-9954

 Personal Information

*Required Field

*Full Name:

Birth Date:

*Primary email Address:

Phone Number:

Mailing Preference:

 Home School

Gender:

 Male Female

Permanent Address:

City:

State:

Zip:

 +4:

College/University You Attend:

School Address:

City:

State:

Zip:

 +4:

Major/Degree:

Current Year in School:

*Expected Graduation Date:

 (00/00)

 

 Fields of Interest

Check all that apply. (A complete list is available online. Once your membership application has been processed you may update your membership information online at www.futurecpa.org/futurecpa/contact/contact.htm.)

Accounting
 Information Technology
 Budgeting/Forecasting
 Mergers/Acquisitions
 Taxation		 Financial Planning
Strategic/Business Planning
 Auditing
 Financial Reporting
 Manufacturing

Do you intend to take the CPA Exam? Yes No

If Yes, (month/year):

How did you hear about the Student Affiliate Membership?

Please check all that apply:

Student Newspaper
 Accounting Club Professor
 Friend
 Other

(To be eligible for student affiliate {non CPA} membership status, an individual must be a high school or college student pursuing an accounting, business and/or computer technology-related course of study).

______________________________________________

 Payment

Prorated Schedule of Membership dues
$20 - MAY, JUN, JUL, AUG, SEP, OCT, NOV
$10 - DEC, JAN, FEB, MAR, APR

Payment:

 Check enclosed (no cash please)
Credit Card

Check or Money Order (payable in U.S. Dollars to Illinois CPA Society

Visa

 MasterCard Discover American Express

Credit Card number:

Expiration Date:

Name on the card:

I understand and agree that as an Illinois CPA Society Student Member that I will be bound by the organization's Code of Ethics. I understand that I will no longer be eligible for student membership once I pass the Uniform Accountancy Exam or when I am no longer a full-time student, but will be eligible for general or professional affiliate membership.

Signature:

_____________________________________
This must be a signature.
Date:

Return via mail or fax:
The Illinois CPA Society
550 W. Jackson, Suite 900
Chicago, IL 60661-5716
Phone: 312/993-0393 Fax: 312/993-9954
Attn: Membership or you can fax in your application 24 hours a day, 7 days a week to: 312/993.9954.

Attn: Membership. APPLICATIONS WILL NOT BE PROCESSED WITHOUT SIGNATURE AND DUES PAYMENT. THANK YOU.